Obama made headway in ending failed war-on-drugs policies, but Trump is betraying those suffering addiction and their loved ones.

USA Today

During the campaign, President Trump committed to addressing America’s drug crisis. He called it “a crippling problem” and “a total epidemic,” which it is. An average of 144 people a day die of drug overdoses. Trump promised increased funding and comprehensive Medicaid coverage for treatment. In March, he said, “This is an epidemic that knows no boundaries and shows no mercy, and we will show great compassion and resolve as we work together on this important issue.”

Trump’s rhetoric suggested a continuation of President Obama’s approach, which was founded on a rejection of the failed 45-year-old war on drugs, which treated drug use and addiction mainly as criminal problems. Obama called that war “counterproductive” and an “utter failure.” His administration emphasized treatment-and-prevention programs based on scientific advances that have demonstrated that addiction is a brain disease with biological, psychological and environmental determinants. Obama championed landmark legislation that funded mental health and addiction treatment programs and research. He signed the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act, which provides resources for state and community prevention and treatment efforts. A godsend to sufferers of substance-use disorders, Obamacare mandated that insurance plans cover mental health, including addiction care, in parity with other diseases.

The administration made headway toward ending the war-on-drugs approach. Obama’s attorney general, Eric Holder, reversed wartime policies, including draconian mandatory minimum sentencing that filled prisons with people convicted of non-violent drug crimes. His surgeon general, Vivek Murthy, released a historic report — as significant as the 1964 surgeon general’s report on smoking — on alcohol, drugs and health, which made science-based prevention and treatment a national priority. The report is a progressive set of evidence-based policy recommendations for preventing substance use, intervening early in cases of drug misuse, and improving addiction treatment. The recommendations were the result of a 24-month review of the past 30 years of science and policy in this field. In addition, Obama’s recent drug czar, Michael Botticelli, spearheaded a movement that rejected the “failed policies and failed practices” of the past and championed prevention, treatment and harm reduction. For the first time, the drug czar’s budget was tipped in favor of prevention and treatment over interdiction and policing.

Trump’s initial comments regarding addiction appeared to reflect both a personal passion and a sensible policy. However, the president is systematically abandoning the addicted and their families. Last month, Trump abruptly fired Murthy and announced that the odd couple of his son-in-law, Jared Kushner, and Chris Christie will lead an effort to create policies to combat the opioid epidemic.

Of immediate concern to the 20 million Americans who meet the diagnostic criteria for the disease of addiction, and the 40 million regularly misusing alcohol and other drugswho are at risk and may require some form of treatment, the president has said that one way or another he’ll end mandates included in the Affordable Care Act.

Trump has said that he’d sign the bill the House passed Thursday that will, if it makes it through the Senate, do just that by allowing states to apply for waivers of ACA-required benefits, including mental health and addiction care. Without that mandated coverage, it’s likely that millions of Americans will lose coverage for an illness that could kill them.

Meanwhile, Trump’s team has begun a re-escalation of the drug war. Attorney General Jeff Sessions, an old-school drug warrior, criticized Holder’s policies and suggested that he’ll reverse them. “You have to able to arrest people and then you’re intervening in their destructive habit,” Sessions said. “Many people never ever recover from addiction — except by the grave.”

They would recover if they had proper treatment.

t’s unsurprising that an administration that has vowed to be tough on crime plans to use battering rams rather than science-based public health efforts — ignoring evidence that the former doesn’t work and that the latter does. In the past, tough on crime was a boon to the prison system, which is filled with hundreds of thousands of people incarcerated for non-violent drug crimes. Any policy that throws sick people in prison is inhumane, never mind counterproductive.

And how about killing them? Doubts about Trump’s compassion toward the addicted were confirmed last weekend when he cozied up to a dictator whose idea of treating drug users is murdering them. According to USA TODAY, his new friend, the Philippines’ Rodrigo Duterte, had at least 6,000 people killed for drug crimes in six months. Duterte doesn’t distinguish between users and dealers. He has exhorted Philippine citizens: “If you know any addicts, go ahead and kill them.”

It’s critical that the Trump administration reverse directions and focus on a public health approach. Science has demonstrated that addiction isn’t a choice made by people without willpower who only care about getting high, no matter the impact on society, their loved ones and themselves. It’s a brain disease. We punish people who make bad choices. But people who are ill don’t need censure, stigmatization or jail time. They need quality care for an illness that can, if it isn’t treated, kill them.

David Sheff is the author of Beautiful Boy: A Father’s Journey Through His Son’s Addiction, and Clean: Overcoming Addiction and Ending America’s Greatest Tragedy. Follow him on Twitter: @david_sheff

Addiction is treatable. So why aren’t more people receiving quality care?

The crisis is well documented and reported: More people are dying of drug overdose than any other non-natural cause—more than from guns, suicide, and car accidents. Politicians have held press conferences, formed commissions and task forces, and convened town-hall meetings. Vivek Murthy, the Surgeon General under President Obama (fired by Donald Trump), issued an historic report on America’s drug-use and addiction crises. Pharmaceutical companies have been blamed. Drug cartels. Physicians who hand out pain pills like Skittles.

In the meantime, the problem worsens. In 2015, 52,000 people died because of overdose, including 33,000 on OxyContin, heroin, and other opioids. Almost three times that number died of causes related to the most-used mood-altering addictive drug, alcohol. The 2016 and 2017 overdose numbers are predicted to be higher. Currently, fentanyl deaths are skyrocketing.

If not politicians, to whom can we turn to address the crisis? Since addiction is a health problem, the logical answer would be the addiction-treatment system, but it’s in disarray.

Currently most people who enter treatment are subjected to archaic care, some of which does more harm than good. Only about 10 percent of people who need treatment for drug-use disorders get any whatsoever. Of those who do, a majority enter programs with practices that would be considered barbaric if they were common in treatment systems for other diseases.

Many programs reject science and employ one-size-fits-all-addicts treatment. Patients are often subjected to a slipshod patchwork of unproven therapies. They pass talking sticks and bat horses with Nerf noodles. In some programs, patients are subjected to confrontational therapies, which may include the badgering of those who resist engaging in 12-Step programs, participation in which is required in almost every program. These support groups help some people, but alienate others. When compulsory, they can be detrimental.

Patients are routinely kicked out of programs for exhibiting symptoms of their disease (relapse or breaking rules), which is unconscionable. They are denied life-saving medications by practitioners who don’t believe in them—as Richard Rawson, PhD, research professor, UVM Center for Behavior and Health, says, “this is tantamount to a doctor not believing in Coumadin to prevent heart attacks or insulin for diabetes.”

Patients are put in programs for arbitrary periods of time. Three or five days of detox isn’t treatment. Many residential programs last for twenty-eight days, but research has shown that a month is rarely long enough to treat this disease. Some of those who enter residential treatment do get sober, but they relapse soon after they’re discharged, with, as addiction researcher Thomas McLellan, PhD, sums, “a hearty handshake and instructions to go off to a church basement someplace.” As he says, “It just won’t work.” Finally, people afflicted with this disease are almost never assessed and treated for co-occurring psychiatric disorders, in spite of the fact they almost always accompany and underlie life-threatening drug use. If both illnesses aren’t addressed, relapse is likely.

The disastrous state of the system suggests that addiction-medicine specialists don’t know how to treat substance-use disorders (or even if they can be treated). It’s not the case. The National Institute on Drug Abuse (NIDA) and organizations of addiction-care professionals like the American Society of Addiction Medicine (ASAM) and American Association of Addiction Psychiatry (AAAP) have identified effective treatments. There’s no easy cure for many complex diseases, including addiction. However, cognitive-behavior therapy, motivational interviewing, and addiction medications, often used in concert with one another and in concert with assessment and treatment dual diagnoses, are among many proven treatments. However, most patients are never offered these treatments because of a fatal chasm between addiction science and practitioners and programs.

Source: Illustration by Jasper Sheff

Fixing the system requires modeling it on the one in place for other serious illnesses. Most people enter the medical system in their primary-care doctors’ offices, health clinics, or emergency rooms. Currently, most doctors in these settings have had little or no education about addiction. A recent ASAM survey of two thirds of U.S. medical schools found that they require an average of less than an hour of training in addiction treatment.

Primary-care doctors should be trained and certified to prescribe buprenorphine, a medication that decreases craving and prevents overdose on opioids. Currently, there are limitations on the number of patients doctors can treat. Still, in Vermont, for example, almost 50 percent of opioid users in treatment receive care in their doctors’ offices- they don’t have to go to addiction specialists or intensive treatment programs to receive care.

When a patient requires a higher level of care, doctors must refer them to addiction specialists, which excludes many current practitioners whose only qualification to treat addiction is their own experience in recovery. Instead, patients must be seen by psychiatrists and psychologists trained to diagnose and treat the wide range of substance use disorders. There’s a shortage of these doctors; there needs to be a concerted effort to fill the void.

According to Larissa Mooney, MD, director of the UCLA Addiction Medicine Clinic, “Individuals entering treatment should be presented with an informed discussion about treatment options that include effective, research-based interventions. In our current system, treatment recommendations vary widely and may come with bias; medication treatments are either not offered or may be presented as a less desirable option in the path to recovery. Treatment should be individualized, and if the same form of treatment has been repeated over and over with poor results (i.e. relapse), an alternative or more comprehensive approach should be suggested.”

When determining if a patient should be treated in physicians’ offices, intensive-outpatient, or residential setting, doctors should rely on ASAM guidelines, not guesses. The length of treatment must be determined by necessity, not insurance. If a patient relapses, is recalcitrant, or breaks rules, treatment should be reevaluated. They may need a higher level of care, but sick people should never be put out on the street. In addition, all practitioners must reject the archaic proscriptions against medication-assisted treatment; Rawson says that failing to prescribe addiction medications in the case of opioid addiction “should be considered malpractice.”

People blame politicians, drug dealers, and pharmaceutical companies for the overdose crisis. However, that won’t help the millions of addicted Americans who need treatment now. Even the most devoted and skilled addiction professionals must acknowledge that they’re part of a broken system that’s killing people. No one can repair it but them.

Sunday Book Review: A Disease, Not a Crime

It must be the purest agony to be the parent of a child succumbing to drug addiction. David Sheff’s previous book was an account of his son Nic’s descent from a thoughtful boy to a sullen pothead to a self-destructive methamphetamine fiend, and of his own tormented and bewildered reaction.

If that book, “Beautiful Boy,” was a cry of despair, “Clean” is intended as an objective, if still impassioned, examination of the research on prevention and treatment — a guide for those affected by addiction but also a manifesto aimed at clinical professionals and policy makers. Sheff’s premise is that “addiction isn’t a criminal problem, but a health problem,” and that the rigor of medicine is the antidote to the irrational responses, familial and social, that addiction tends to set off.

Sheff, a journalist, writes that America’s “stigmatization of drug users” has backfired, hindering progress in curbing addiction. The war on drugs, he says bluntly, “has failed.” After 40 years and an “unconscionable” expense that he estimates at a trillion dollars, there are 20 million addicts in America (including alcoholics), and “more drugs, more kinds of drugs, and more toxic drugs used at younger ages.”

Sheff says that drug addiction is a disease as defined by Stedman’s Medical Dictionary, since it causes “anatomic alterations” to the brain that result in “cognitive deficits” and other symptoms. But isn’t drug use an act of free will, distinguishing addiction from other diseases? Sheff responds that behavioral choices contribute to many illnesses: think of unhealthy diets and diabetes.

Like other diseases, addiction has a substantial genetic component. Mental illness and poverty are major risk factors. These susceptibilities help explain why 80 percent of adolescents in the United States try drugs, but only 10 percent become addicted. Sheff emphasizes the vulnerability of adolescents. Neuroscience corroborates our intuition that their impulsivity develops faster than their inhibitions, and drugs may stunt their emotional growth, making them yet more prone to addiction.

Although the medical approach to drug abuse has yielded techniques with proven effectiveness (Sheff’s touchstone is ­“evidence-based treatment”), he is scrupulous about not overselling it. “Addiction medicine isn’t an exact science,” he concedes, “and it’s still a relatively new one.” Treatment programs have success rates that are only comparatively less dismal than doing nothing. Just a small minority — even the claim of 30 percent may be inflated — of addicts who have been treated remain sober for a year. “The persistent possibility of relapse,” he says, is a “hallmark of addiction,” which he calls a chronic disease requiring lifelong vigilance. He laments the variable quality of treatment programs. Even in some expensive clinics, medical professionals are scarce, and the worst programs border on “voodoo.”

Sheff may lose some readers as he sprints through the research for every aspect (neuroscience, social science, psychology, law) of every stage (preventing early use, identifying abuse, detox, treating addiction, maintaining sobriety) of every drug problem. Though leavened by profiles of addicts and their healers, “Clean” feels overstuffed and miscellaneous, in the same way that a 300-page overview of everything we know about cancer would.

Nevertheless, Sheff is a skilled journalist on an urgent mission. He prevailed over the anger and hopelessness he felt at his son’s affliction by calling upon great reserves of love and discipline to investigate what might help — first as a father and then, in this book, as a reporter and an advocate. His forbearance and clearheadedness could serve as an example for America as it confronts its drug problem. He has performed a vital service by compiling sensible advice on a subject for which sensible advice is in short supply.

Addict’s Father, Now Advocate

“Beautiful Boy” was a page turner, a dark fable that spoke to worried parents everywhere. “Clean” is a reference work and a manifesto, an annotated map of the same frightening territory where dragons still lurk at the edges.

In “Clean,” Mr. Sheff changes perspective, writing as advocate and journalist rather than distraught father. Still, his story line recreates that of “Beautiful Boy,” tracing the trajectory of addiction from cradle to rehab and beyond with the same question in mind: How does a promising cleareyed kid from a good family wind up in an inconceivable sea of trouble?

His answer, bludgeoned home with the repetitive eloquence of the missionary, is entirely straightforward: The child is ill. Addiction must be considered a disease, as devoid of moral overtones as diabetes or coronary artery disease, just as amenable as they are to scientific analysis, and just as treatable with data-supported interventions, not hope, prayer or hocus-pocus.

This perspective is easy enough to articulate but very difficult to sustain — hence Mr. Sheff’s determined reiterations. The symptoms of this particular relapsing illness, after all, include deceit, denial and the betrayal of near and dear. Cardiac patients stop to rest halfway up a flight of stairs not because they want to, but because they have to. Similarly, addicts lie and steal, over and over again, not because they want to but because they must.

Wrapping the mind around this formulation requires an enormous act of will, and it is Mr. Sheff’s foremost achievement that his arguments are likely to influence even the angriest and most judgmental reader.

In 2013, he was the Media Award from the College on Problems of Drug Dependence/National Institute on Drug Abuse

David Sheff is receiving the ASAM 2017 Media Award to recognize a person or entity that improves the public’s understanding of addiction, addiction treatment, recovery, or the profession of addiction medicine through the use of a media or publication source.

Interview with Ai Weiwei

The artist Ai Weiwei is the Chinese government’s worst nightmare: an internationally revered art star who uses his work and celebrity to advocate for democracy and free speech in a nation with neither. The government has employed a draconian campaign to silence him. Ai is under constant surveillance. He has been threatened, placed under house arrest and physically attacked by a police officer. Ai’s incendiary blog, read by thousands of Chinese citizens, disappeared one day. And so did he: In 2011, state police grabbed him at the airport, threw a black bag over his head and drove him to an undisclosed location, where he languished for 81 days in a tiny prison cell. Despite these attacks, Ai has continued his virulent criticism of the Chinese Communist leadership, which he deems repressive, immoral and illegitimate.

The first time he forced Nic into treatment, said Sheff, the youngster tried to kick out the car window in an effort to escape.

Sheff — author of the bestselling “Beautiful Boy: A Father’s Journey Through His Son’s Addiction” and the subsequent (and also bestselling) “Clean: Addressing Addiction and Ending America’s Greatest Tragedy” — recounted some of his journey before a packed audience during a psychiatry grand rounds lecture in the auditorium of 55 Park St. His talk, co-sponsored by the Poynter Fellowship, was also the Department of Psychiatry’s annual Ribicoff Lecture.

Today, following a decade of personal experience and years of journalistic research, Sheff is convinced that addiction is, in fact, an illness, and believes that it cannot be prevented and successfully treated until that fact is commonly accepted and understood. He said the addict should be treated with as much compassion as someone with cancer or any other disease.

During his talk, Sheff recounted the “years of hell” that he and his family lived through while watching Nic “descend” deeper into addiction and relapse “time after time after time.” His life, the journalist said, was a rollercoaster of despair, hope, and fear. Every time his phone rang, he wondered if it would be the call from police announcing that Nic was dead. In the throes of drug use, Nic would disappear so often that the local police dispatcher became accustomed to Sheff’s phone calls asking if there was any news of his son, and once suggested that the father try calling the morgue.

Since writing “Beautiful Boy,” Sheff said he was received thousands of letters from parents who have been through the same anguish. He realized that his family “was one of the lucky ones,” he told his audience. Nic, now 31, is celebrating his fifth year in recovery.

His own investigation into the causes and treatment of addiction led Sheff to visit research laboratories, clinicians, drug treatment centers, crack houses, emergency rooms, 12-step programs, needle exchange programs, and prisons. What he learned convinced him that addiction is a neurological and genetic disease.

Scans of addicts’ brains, he noted, show “startling” anatomical and structural differences. He also cited work being done by Ulrike Heberlein at the University of California-San Francisco with fruit flies, which has demonstrated that cravings for drugs “trump basic survival instincts.” The addicted flies would repeatedly suffer electric shock to obtain alcohol or cocaine.

Recognizing addiction as an illness is the first step toward solving the public health tragedy, Sheff told his audience. He noted that addiction is the number-three cause of death in America, killing 350 people daily.

“We are losing one person every 19 minutes — after cancer and heart-related deaths,” said Sheff, who argued that greater attention must be paid to understanding and treating addiction.

The journalist acknowledged that it will take a “culture shift” to change people’s thoughts about addicts, noting that most believe drug abusers have a choice over whether or not to use drugs. Sheff said that one in 10 of the 80% of people who try drugs before the age of 18 become addicts.

“People are threatened … [T]hey don’t want to accept that sometimes behavior is not in our control. Our culture emphasizes self-determination and willpower,” he said. “We want to be masters of our own destiny, but sometimes we aren’t.”

He advocated for education about addiction — not only for the public but also for physicians, most of whom are not trained to identify or treat addiction, Sheff claimed. Since drug use commonly begins in the teenage years, pediatricians are among those who should be well trained, he said.

Asked why they take drugs, most youngsters cite stress as the biggest factor, Sheff said, and thus treating that is key to preventing drug or alcohol abuse.

“We can only help [end addiction] when we stop focusing on the drugs themselves and focus on why people use them,” said Sheff, adding, “Stress is related to addiction on the most primal level.”

He said that genetics and psychological disorders — including anxiety, bipolar disorder, depression, and trauma — are also contributing factors.

“It’s useless to tell the child who is being bullied or failing in school, or who is being traumatized by family turmoil, to ‘Just say no,’” maintained Sheff. “It’s pointless to tell our children to make good choices about drugs if they offer them a reprieve from the darkness they feel or the connection that they so badly crave. People in pain are desperate for relief.”

Sheff recounted how some of the “treatments” his own son had were punitive rather than compassionate. For bad behavior at one facility, Nic had to cut the grass with scissors and clean grout with a toothbrush.

Sheff said 12-step programs also may fail with teenagers, as “what 17-year-old admits he is powerless about anything or turns his life over to another person?”

The journalist decried the hesitancy of some drug therapists to prescribe medications such as suboxone (or buprenorphine) for opioid dependence because they don’t want to treat drug dependence with other drugs. Scientific evidence has shown that such medications can be beneficial, said Sheff, arguing that addiction treatment must be evidence based.

In Nic’s case, Sheff noted, it took years before a doctor conducted psychological testing that revealed his son suffered from bipolar disorder and depression. Previous treatments might have been more successful had he been diagnosed earlier, Sheff suggested.

While some discouraged Sheff from writing about his family’s experience of addiction, the author said the response he has received since the publication of his books has been wholly positive and empathetic. He said that stigma is “the single biggest roadblock” to treatment and an understanding of addiction.

“We don’t know how pervasive addiction is because addicts and families already keep it secret,” he said, later adding: “When we choose to no longer hide our own or our child’s addiction, we can feel tremendous relief … We can learn we are not alone.”

Sheff said that he is hopeful about the future, in part because President Obama’s Affordable Care Act requires mental illness, including addiction, to be treated the same as physical illness, and insurance can now fully cover addiction treatment. Some best practices in the treatment of addiction are being established, and the families of addicts have started some grassroots movements, much the same way AIDs activists did in the 1980s, Sheff said.

“I’m hopeful because of people like you in this room,” concluded Sheff, referring to the Yale doctors and researchers who are actively engaged in trying to better understand and treat addictions.

Sheff was introduced by Dr. Robert Malison, professor of psychiatry and director of the Clinical Neuroscience Research Unit and the Neuroscience Research Training Program, as well as chief of the Cocaine Research Clinic. He called Sheff’s books about addiction “a testament to a father’s love for his son,” and added, “We are working our hardest to make good on what you, David, would like to see realized.”

PARENTS of drug-addicted kids learn the hard way that when we think things can’t get worse, they do. As a teenager, my son, Nic, was addicted to methamphetamine, heroin and other drugs. At 20, he had used most of the illicit drugs known to man. But one night, partying with a couple of friends in his basement apartment in Brooklyn, the combination and volume caused him to overdose. One of his friends called 911.

Nic was rushed to the emergency room, where he was resuscitated. When I spoke to a doctor there, I was told that if another 15 minutes had passed before Nic got to the E.R., he wouldn’t have survived. My son has now been sober for five years. I don’t know who called the paramedics, but not a day goes by when I don’t thank him.

Other parents haven’t been so lucky.

So many of the stories I’ve heard, from parents who have read my accounts of Nic’s addiction, begin the same way. He was a wonderful child, a good student. She was popular, a hard worker.

David C. Humes described his son Greg as “Wonderful and bright. A.P. courses, good athlete. Warm. Loving.” On May 19, 2012, “Greg’s earthly story ends,” David told me. His son overdosed and passed out. Someone — David doesn’t know who — dragged Greg outside and placed him in the back seat of his own car. The person then drove Greg to the hospital and left him in the parking lot, where he was found dead.

A few days ago I heard from another father. He told me about his only child, Steve, who overdosed on a combination of OxyContin and Jack Daniel’s. Steve’s friends — “friends” may not be the appropriate word — put him in an ice-filled bathtub, a misguided intervention they had seen on TV. Steve died. His friends didn’t call for help because they were afraid they would be arrested, and they probably would have been.

These children are among many thousands whose lives may have been saved if someone had called for help, and more are dying every day. There’s no reliable data on the number of overdose deaths that could have been prevented had help been summoned immediately. But research suggests that, among those who witness an overdose, the most common reason people don’t call for help is the fear of being arrested.

Meanwhile, the death toll keeps rising. Rates of lethal overdoses — now mostly with prescription opioid pain medications, like OxyContin, and street drugs like heroin — have more than tripled since 1990, leading to over 38,000 deaths in the United States in 2010. Overdose has become the No. 1 nonnatural cause of death in the country.

Responding to this epidemic, 11 states — including North Carolina earlier this month — and the District of Columbia have enacted laws that encourage people to intervene at the scene of a drug overdose. These laws, generally, shield a person who calls 911 from arrest and prosecution for drug use or possession, underage alcohol use and similar crimes. (A few other states offer weaker protections for 911 callers in overdose cases, and many already have so-called “Good Samaritan” laws that protect people from being sued if they are at the scene of a non-drug-related accident and try to help.)

The law that recently took effect in the District of Columbia is among the more comprehensive of the statutes — preventing evidence from being used against a person who called emergency services “if it was found through the process of providing health care.” The law also ensures that a person who calls 911 can’t be arrested, in connection with that call, for a parole violation, and protects people who themselves are OD’ing if they call for help.

Such legislation, of course, won’t touch the problem of addiction; nor will it prevent every death from overdose. But it will save lives.

That message had been lost on Gov. Chris Christie of New Jersey, who “conditionally vetoed” a similar measure last year after it passed the state legislature with bipartisan support, saying it would have let drug dealers “off the hook.”

“How about if the person calling is not a Good Samaritan?” Mr. Christie asked at the time of his veto.

Fortunately, in the months since, Mr. Christie appears to have had a change of heart, thanks to lobbying by parents whose children have died from overdoses. Today, Mr. Christie is expected to announce his support of an “Overdose Prevention Act” that includes a Good Samaritan provision. Should the law pass in New Jersey, that would still leave more than three dozen states without protections for those who call 911 in OD cases.

One state on that list is Pennsylvania, where David Humes’s son died. “If they had this law,” says Mr. Humes, “maybe it would have saved my boy’s life.”

David Sheff is the author, most recently, of “Clean: Overcoming Addiction and Ending America’s Greatest Tragedy.”

A “Celebrity Boutique” Celebrates Drug Use at Children’s Expense

The banner on the website of Kitson, the self-described celebrity boutique whose customers include Taylor Swift, Reese Witherspoon, and Paris Hilton, reads, “Pop one on and you’ll feel better. Just what the doctor ordered.” The prescription is for customers to check out the company’s line of jerseys and sweatshirts emblazoned with the words VICODIN, XANAX, and ADDERALL, three of the most misused prescription medications, the class of drugs now killing more people than any other nonnatural cause, even traffic accidents.

Pop references to drugs are nothing new. Miley Cyrus’s twerking at MTV’s Video Music Awards was talked about more than Syria, but not much was said about the song she sang that made “dancing with Molly” sound pretty great. Molly is MDMA—Ecstasy, the drug that killed two kids and left others in critical condition at the Electronic Zoo music festival in New York City on August 31. (The New York Times has reported more deaths since then.) Nicki Minaj, Madonna, Kanye West, Rihanna, and Rick Ross also sing the praises of Molly, but those endorsements are simply the latest in the tradition of countless songs, movies, TV shows, and products that make drugs seem awesome.

Earlier this year, Urban Outfitters launched its own prescription-themed product line that included syringelike shot glasses, and flasks designed to look like bottles of medications. In the script on a beer cozy, users were advised, “Take one can by mouth, repeat until intoxicated.” (Urban Outfitters has been a frequent target of criticism for products that some have viewed as offensive, including an “Obama Black” T-shirt, an EAT LESS tank that depicted an emaciated model in a miniskirt, and a game, Ghettopoly, with bonus cards that had messages like “You got yo whole neighborhood addicted to crack. Collect $50.”) This company’s drug-themed products one-up Kitson’s, because they simultaneously advertised two drugs, prescription pills and alcohol, which in combination are more dangerous than either on its own.

Angry protesters waged Facebook and Twitter attacks on the company, just as they’re currently targeting Kitson and the clothing line’s designer, Brian Lichtenberg. The constituency of people enraged by products that make light of drugs or, worse, glorify them, is not one with which any prudent company would want to tangle. Many are parents who have lost children to prescription medications. They’ve been flooding Kitson’s Facebook page for the past two weeks. A typical post reads: “As a grieving parent who lost my youngest son to an overdose of Xanax and Vicodin I find your promotion of the non-medical use of prescription drugs to be pathetic.” Another: “You obviously haven’t had a son or daughter die in your home from an overdose on prescription pills, as I have.”

Many parents have posted photographs of their children who have overdosed and died. Every photograph — each child shining with the promise of a long and productive life — has a simple caption:

“This is my son. He died from a drug overdose. You make me sick with your merchandise.”

“Salvatore Marchese, 4-11-84 to 9-23-10.”

“Here’s my son Jarrod. He WAS 19.”

“Zachary Parsons (23) 1988-2011.”

“Jacquilynne July 14, 1978 — August 21, 2012”

Lichtenberg responded on Facebook, defending his collection as “simply a commentary on what I see happening in our society.” He said, “Mission accomplished” [if the shirts] “open the door to a much-needed dialogue.” Kitson released a statement that it would donate proceeds from the shirts to Partnership at Drugfree.org’s Medicine Abuse Project, but the organization rejected the offer as long as Kitson “flagrantly, and without remorse, continue[s] to sell these products.” The organization’s president, Steve Pasierb, wrote to Kitson CEO Christopher Lee, “Tongue-in-cheek products that normalize and promote prescription drug abuse only serve to reinforce the misperception about the danger associated with abusing medicine and put more teens at risk.”

The bereaved parents and many others also contacted the pharmaceutical companies that sell the medications. Xanax producer Pfizer said that it’s considering legal action. Shire, manufacturer of Adderall, said in a statement, “The use of ‘Adderall’ by Kitson in this manner represents an unauthorized use of Shire’s ‘Adderall’ trademark. Further…it gravely concerns Shire as it glorifies the misuse and diversion of a federally controlled prescription drug for the treatment of ADHD…. Shire is currently assessing its options to address this unauthorized use of the Shire trademark ‘Adderall.’ ”

One champion of the cause has been the actress Kristen Johnston, star of the sitcoms The Exes and Third Rock From The Sun and the author of the addiction memoir Guts. Johnston has rallied her fans and followers online. Her initial missives about the drug-themed shirts were tempered, written to inform Kitson and Lichtenberg about the problem of prescription-drug abuse. In response, the company posted on its Facebook page a comment that’s testament to public relations and marketing at its most ill-advised: “We will stop selling the t-shirts in question if tv [sic] networks agree to stop accepting ad revenue from prescription drug companies. We invite Kristen Johnston to join us in this call to action since she is a working actress on a show owned by a national network, and actors’ salaries are directly affected by advertising revenue.”

Not able to leave well enough alone, Kitson also went after Today Showcoanchor Tamron Hall, who, during a report on Kitson’s drug-themed shirts last week, called the company irresponsible, saying, “People should probably not shop there until they get that [the drug shirts] out.” Kitson filed a formal complaint with the Federal Communications Commission, which raises a question: By fueling the flame, are the company’s executives cynically calculating that even bad publicity is good publicity? On the show, Hall said, “Think about how many kids are dying.”

Between the lawsuit threats and public outcry, it’s probably only a matter of time before Kitson caves. Urban Outfitters did, though even as the company pulled the offensive products, its attitude about it was snarky, dismissing those who complained as too square to understand products “that represent humor, satire, and hyperbole.” The company’s press release continued, “We recognize that from time to time there may be individual items that are misinterpreted by people who are not our customers.” It’s impossible to know if many Urban Outfitters customers, including not a few receptive young teenagers, grokked the subtlety or irony in the products that would have them squirting tequila out of syringes down their throats (LOL!). Certainly there’s nothing subtle or ironic about teenagers shooting dope, swallowing OxyContin, or downing a dozen Jäger shots.

As long as there’s a drug problem in America, it’s likely that protests against whatever products and media glamorize drug misuse will continue. Already, legislators and other politicians have been enlisted to speak out against those who feed youth culture with overt and subliminal messages that idealize getting high. On September 6, the attorneys general in Florida, Kentucky, and Maine weighed in the about Kitson matter. Florida AG Pamela Bondi said, “Your tee shirts do not ‘open the door to a dialogue,’ as the designer claims, and donating some or all of the profits to a non-profit does not make this bad idea better.”

It’s typical of companies, actors, filmmakers, musicians, and other artists to defend their right to portray drugs (or guns, or sex) in whatever ways they want, as Kitson did, citing artistic freedom and railing against censorship. And like Lichtenberg, they commonly maintain — and genuinely may believe — that they have no influence on behavior and attitudes, that they’re just reflecting drug use, not promoting it.

Their arguments are, at best, disingenuous. The protestors against Kitson aren’t calling for censorship; in America, we don’t censor people for being callous, stupid, mercenary, immature, or grossly irresponsible. But it’s patently false to claim that pop culture doesn’t influence kids. They help normalize and romanticize drug use.

Obviously images and media aren’t at the root of America’s drug problem—it’s infinitely more complicated — but they contribute to it. Studies have long shown that media messages have a pronounced impact on childhood risk behaviors. For example, a study of 16,000 teenagers in six European countries found that the more that kids saw drinking in movies, the more likely they were to binge drink. When Snoop Dogg raps about smoking endo (marijuana) and sipping on gin and juice, it sounds sublime. Some of the better Seth Rogen stoner movies make me want to get high.

Advertising and product placement work. Heineken wouldn’t have paid the creators of the latest James Bond movie, Skyfall, $45 million to have Daniel Craig eschew his usual martini in favor of a beer if it had no impact on viewers. When there’s a Heineken in Craig’s hand, the brand seems fashionable and sophisticated. Emblazoned on a designer’s $98 sweatshirt, Vicodin does, too. The Kitson T-shirts, with their hidden wink-wink-we’re-so-fabulous-in-the-know-and-fuck-off-if-you-don’t-like-it messages, reinforce a culture in which drugs are hip, drug users have all the fun, and those who abstain are nerds and losers.

Whether or not Kitson pulls the drug-themed shirts, it’s naive to think that companies and artists will stop depicting drug misuse positively and, subtly or overtly, promoting it. Meanwhile, the outcry from enraged parents and others who want to protect children will become louder. Ironically, these offensive products serve the parents’ cause in one way: They unify angry people who rally together, and the movement builds.

Their desire isn’t for censorship, but responsibility.

What will it take for a head of an apparel company, studio executive, director, designer, musician, music-label chief, or actor to draw a line and refuse to participate in anything that makes it seem totally cool to get wasted? I hope it doesn’t take what drives many of the protesters: the death of someone they love.

When my teenage son was raging out of control on drugs — wasted on crystal meth and heroin, careening toward death — I finally got him into treatment, the first of a dozen rehab programs he would go to. This program included lectures for family members, like one titled “The Disease of Addiction.” By then Nic had lied to me, broken into our home, and stolen from me — and even from his little brother, too. I thought I’d raised a kind, moral, and loving child, but something had gone horribly wrong. As I listened to the speaker talk about addiction as a disease, Nic was in a lockdown ward in a wing of the hospital. Getting him there had been hell — he almost leaped out of our moving car and had tried to kick out the window. My son wasn’t ill. He was selfish, reckless, and remorseless, a narcissistic teenager obsessed with being high, with no concern for his family.That was the first time I heard what is sometimes termed “the disease theory” of addiction, but it wasn’t the last. I tell about my struggle to understand that addiction is a disease in my book Beautiful Boy, about about my family’s struggle when Nic became addicted. The disease theory was repeated in more lectures at more rehabs, in countless therapists’ offices, and in many Twelve Step meetings I attended. I’d become enraged by it. People with leukemia have a disease. Those with Alzheimer’s or lymphoma have a disease. Nic was choosing to use and could stop if he wanted to. There was no such option for cancer patients.

Meanwhile, I struggled to make sense of what had happened to my son.

My perplexity, not to mention my fear, led me to spend the next ten years investigating this thing called addiction. I wanted to confirm my view about espousers of the disease theory, that they were looking for an excuse for addicts’ appalling behavior.

As I report in my latest book, Clean: Overcoming Addiction and Ending America’s Greatest Tragedy, a disease, according to Stedman’s Medical Dictionary, is “an interruption, cessation, or disorder of a body, system, or organ structure or function” and “a morbid entity ordinarily characterized by two or more of the following criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomic alterations.”

In researchers’ laboratories, I was shown scans of addicts’ brains compared with ones of “normal” brains that showed startling differences in the ways they functioned. Researchers showed how the brains of addicts responded to drugs differently than did nonaddicts’ brains. They explained the consistent anatomic aberrations found in the brain structure of addicts and the disruption they had of the normal flow of neurotransmitters through the nervous system. I was informed about research that demonstrated that addicts’ brains were different even before they took drugs and given incontrovertible evidence of genetic components of addiction.

I also learned about functional differences in addicts’ brains and common symptoms associated with addiction. Over time, addicts’ neurological systems build up a tolerance to a given drug. Because they become physically dependent on the drug, they experience withdrawal symptoms, some potentially lethal, when they’re deprived of the drug. Craving and associated drug-seeking behavior are other typical symptoms. All of these symptoms are caused by biology, not choice. Impairments include a range of cognitive deficits and compromised motor functions. There are measurable anomalies related to autonomic body functions.

Over time I became convinced. The evidence was undeniable. Addiction is a disease, but a unique disease because of the associated behavior. And it’s unique because it appears that people choose it.

People do choose to use drugs — at first. Nic chose to get high, but so do most other children. Before they are eighteen, 80 percent of our kids do. Most of them stop or continue to use in moderation, but some, about one out of ten, become addicted. Like Nic. He was twelve when he smoked pot for the first time. His use quickly escalated, and by the time he was eighteen, he was addicted to it. Nic didn’t choose to become addicted. No one does. Once addicted, sufferers of the disease continue to use in spite of a desire, at some point desperation, to stop. Often they repeatedly try to stop, but they can’t. Addicts’ brains are different than others’. This is a disease that impairs the parts of the brain that would normally cause people to control their impulses.

My son was ill — seriously ill. The disease of addiction is chronic and progressive. If it isn’t treated, it can be fatal. It became clear to me: Nic could die of this disease.

I’ve heard some people say that addiction shouldn’t be considered a disease because a diagnosis would discourage addicts and their families, as if it were a sentence that would doom them. But I was relieved when I understood that Nic was ill. Nic’s unconscionable behavior made sense. I heard addicts describe the need for drugs as as powerful as the need for oxygen. Deprive a person of oxygen, and he will kick, scratch, and fight for more. Deprive an addict of drugs, and he will lie, steal, and do other irrational things — whatever it takes — to get more. The diagnosis was also a relief to Nic, who’d been as mystified as I was by behavior of his that he, too, found inexplicable.

I gathered my research in Clean. The book considers the social, political, biological, health, behavioral, and other aspects, including the consequences, of the disease of addiction. One of my goals for the book was to once and for all prove to skeptics that addiction is a disease. It wasn’t merely an intellectual exercise. I came to understand that people must know that addicts are ill if our society is ever going to solve the myriad problems associated with addiction, which is now the number-three killer in America, costing the nation $425 billion for health care, criminal justice, and lost productivity.

Clean was published in April of this year. I braced myself for attacks about some of the stands I take in the book. I expected some readers and special-interest groups to vehemently disagree with my positions on marijuana legalization and the war on drugs. (I concluded that marijuana, though dangerous for adolescents, should be legalized and that the war on drugs had failed and should be ended.) I expected some drug-treatment professionals to attack conclusions I’d made about, for example, the dangerous constructs of “hitting bottom” and cold-turkey detox (they potentially lead to death and should be rejected) or the usefulness of pharmacology in the treatment of some addictions (contrary to the adamant view of some, you do treat some drug problems with drugs). But those subjects turned out to be far less contentious than my attempt to prove that addiction is a disease.

Recently, my friend Mike Moritz, chairman of Sequoia Capital, wrotean article called “Why Is Addiction Still Considered a Personal Weakness?” tackling the subject. “When we hear about someone with a heart problem, HIV, cancer or diabetes we conclude they are ill,” Mortiz wrote. “If we encounter people whose throats close when they eat peanuts or require epinephrine shots if they mistakenly eat shellfish, we understand there are aspects of their genetic wiring that make them susceptible. Yet when we hear about someone with a drug or alcohol problem, they are all too easily dismissed as weak, self-indulgent, indolent, sinful, narcissistic, debauched and feeble failures. Why don’t we assume that drug and alcohol addicts are ill and often seriously and chronically sick?”

Many people were vitriolic in their responses to both his article and my book. Their vehemence and anger caught me off guard. A man wrote, “I have no sympathy for people who make bad choices, and that’s what addicts do. They’re derelict and must be treated as such.”

“I don’t want my tax dollars or insurance premiums or whatever else wasted on other people’s bad choices,” another responded. “The label of ‘disease’ for drug addictions evokes way too much sympathy from people, and thus is misleading. And it is THAT which I cannot stand.”

Yet another: “It’s simple. People make choices in their lives. They make good or bad choices. Their choices are informed by their consciences or lack thereof. Addicts have chosen their own pleasure over everything and everyone. I have no sympathy.”

And more:

“You can make the decision to use drugs or not to. That’s called will power. Some people have no will power.”

“Addiction to substances such as narcotics, alcohol, nicotine, or others is … a choice or lack of will to change.”

“It’s a personal weakness.”

“I’m sick of this ‘oh, poor addicts, they have a disease.’ Addicts just like being high more than they like being sober. They don’t care about the consequences of this choice, which is why they’re reprehensible.”

I realized that if my goal now was to convince people that addiction is a disease, I had my work cut out for me. I learned that I’m taking on deeply rooted prejudices. For some people, the bias is grounded in a belief that if addicts were seen as ill, they’d be off the hook for the choices they made, including reprehensible behavior — violence, or unconscionable actions that break up families and send some addicts to prison. I also determined that the intense reaction comes because people are threatened. They don’t want to accept that sometimes our behavior is not in our control. Our culture emphasizes self-determination and willpower. We want to be the masters of our own destiny.

But sometimes we aren’t.

No matter why people respond to the idea with such vehemence, addiction is a disease — a brain disease.

Why does it matter so much what people think? It matters because we judge and punish people who make bad choices. We demand of them confession and contrition. On the contrary, when people are ill, we treat them with compassion, and the course forward is clearer. People who are ill don’t need blame, chastisement, or punishment — they need treatment.

Why We Should Treat, Not Blame Addicts Struggling to Get ‘Clean’

It has been more than 40 years since Richard Nixon called for a “war on drugs,” and yet our prevention and treatment efforts have largely failed to address the chronic illness of substance addiction that afflicts one in 12 Americans and affects millions more friends and family members.

Journalist David Sheff’s son Nic began using marijuana and alcohol at the age of 12, then heroine and crystal meth. Sheff was baffled; his son transformed from an intelligent student and athlete into an addict living on the streets. At first he thought Nic was just being a wild teenager who needed some tough love. But after struggling to find Nic treatment — and keep him alive — Sheff realized that his son was dealing with a serious disease, more similar than different from diabetes, hypertension or even cancer.

With his personal experience and more than 10 years of research, Sheff concluded that addiction is a health crisis with a price tag of $600 billion nn combined medical, economic, criminal and social costs every year.

In a follow-up to his memoir “Beautiful Boy,” David Sheff has written a new book, “Clean: Overcoming Addiction and Ending America’s Greatest Tragedy,” in order to outline a slew of reasons why society and addiction treatments have largely failed to help the 20 million Americans with addictions.

Sheff asserts that the reason that addiction treatments overwhelmingly fail is because of how we view addiction. And he says correcting common misconceptions about the disease can be the first step towards improving the social support and medical treatment systems for those struggling with their addictions.

Below are the top myths about addiction, according to David Sheff. Do you agree or disagree?Let PBS NewsHour know what you think by leaving your comments in the discussion section at the bottom of the page.

Myth No. 1: Good kids don’t use drugs, bad kids do.

As our children grow up, we — parents, teachers, the culture as a whole — tell them that good kids abstain, bad ones use. Yet 80 percent of America’s children will at least try alcohol or other drugs. Do we really believe that most of our children are bad? As a pediatrician told me: “These aren’t bad kids. They’re our kids.”

By moralizing the choice to use or not, we’re alienating our kids. This isn’t a question of good and bad, it’s a question of health and safety. If we keep this in mind, we can better help our kids grow up without succumbing to drugs and continuing to use, trying new and more dangerous drugs, and even become addicted.

Myth No. 2: It’s impossible to prevent drug use. Kids who are going to use are going to use.

We’ve failed to prevent use because we’ve done most things wrong by focusing on drugs as a criminal and moral problem, and on scare tactics and hyperbole. Prevention efforts will be effective when we focus not on “just say no” tactics, but instead address the reasons kids use.

Kids who have drug problems often use drugs as a way to alleviate stress and otherwise help them cope with stressful lives. Kids who experienced trauma are more likely to have drug problems. The list of risk factors goes on: those growing up in poverty or violent neighborhoods, children whose parents divorce or suffer loss, those with addiction, including alcoholism, in their family, young people with ADHD, with learning disabilities, with a host of psychological disorders including depression and bipolar disorder.

We’ll effectively lower or potentially prevent drug use when we address these risk factors and replace them with protective factors.

Myth No. 3: People who get addicted are weak and without morals.

Addiction is a disease. This isn’t about character. People who think that addicts are weak assume that will power is enough for a person to stop using.

So if weakness isn’t the reason why, when someone’s life is negatively affected by their drug use, why don’t they just stop? It’s because their brains have altered so the new “normal” is the presence of drugs.

Dependence is real, not a choice, biologically rooted, and therefore addicts must be treated. It’s critical that people understand that addiction is a serious illness, usually chronic and progressive and often fatal. Addiction is the cause for 120,000 deaths each year.

Myth No. 4: Addicts must hit bottom before they can be treated.

This myth kills addicts. Don’t wait for an addict to hit bottom; do everything you can to get them into treatments. Addicts are often told that they must hit bottom, but they need to know that people who enter treatment can and do get well. Many people die before they hit a bottom. We must reject this archaic belief.

Myth No. 5: You don’t treat drug problems with drugs.

Wrong again. Many addiction treatments can and should include medication. A variety of medications, when prescribed, monitored, and adjusted by a good psychiatrist, in combination with behavioral therapies, dramatically up the odds of successful treatment.

For many addicts, the impact of medications can be profound — even lifesaving. And for addicts with concurrent mental illnesses, drugs can be essential. Some of the same medications that help during detox can be part of primary care. Some of these prescriptions inhibit cravings. Some treat the symptoms that come with sobriety following intense and consistent drug use. Some replacement drugs not only reduce cravings but act as deterrents; they block certain drugs from attaching to receptors, thereby preventing the drugs from triggering a high if they’re taken. In addition, medications can treat the concurrent and underlying problems, including anxiety, depression, and other disorders, that contribute to addiction.

Myth No. 6: The only way for addicts to stop using is by going to AA meetings.

Alcoholics Anonymous (AA) and the Twelve Steps have helped countless addicts get and stay sober. It’s a profound program that works for many people. But it doesn’t work for a majority of addicts.

People must know that there are other treatments that are effective. Some are used in concert with AA, but AA isn’t a requirement to managing addiction. When treatment programs insist that patients must practice the Steps, they can alienate some addicts, often teenagers.

Effective programs should offer many types of treatment, including behavioral and psychological treatments. As I said, some addictions should be treated with medication in addition to behavioral treatments.

Myth No. 7: Marijuana is not addictive. No one’s ever died from marijuana. It’s not a gateway drug. Marijuana shouldn’t be legalized.

Marijuana should be legalized, but not because it’s safe, especially for teenagers and young adults. It should be legalized because we must treat marijuana use like all drug use — as a health issue. The fact that it is illegal just drives using marijuana underground. The last thing we want to do is increase those things by kicking kids out of school or throwing them into the criminal justice system because they were caught smoking pot.

But those who support legalization by saying that pot is harmless — “it’s natural, innocuous” — are also wrong. Marijuana is dangerous for kids. Part of the reason is that their brains are developing during adolescence and early adulthood. Drugs impede and alter the brain development, and these changes can harm cognition and memory, and can impede kids’ emotional maturation.

Marijuana is a gateway drug for some kids who smoke; I’ve never met an addict who started on heroin — it’s always pot and drinking. And marijuana is addictive for about 7 percent of those who try it. Yes, people don’t overdose and die from smoking pot, but those who drive while high are twice as likely to get in car accidents, including ones that are fatal.

Myth No. 8: America’s drug problem is unsolvable.

We’ve failed at solving America’s drug problem not because it’s impossible to do so, but we’ve been focusing on the wrong things. The main problem is that we’ve treated drug use as a criminal problem and drug users as morally bankrupt.

There are several developments that make me optimistic that we can lower drug use, treat addicts and potentially solve many of the problems in America caused by addiction:

There’s a growing understanding and acceptance that addiction is a disease and must be treated like we treat other diseases.

There are advances in treatment that will dramatically improve the likelihood that addicts will get well. There are also new prevention strategies, early assessment, and brief intervention strategies that work.

There is progress toward making sure that people who need treatment will be able to find programs that use evidence-based treatment.

There is a new organization founded called Brian’s Wish To End Addiction — modeled after the American Cancer Society — that will work to educate the American public, support research and lobby Congress, all in order to improve addiction treatment and care. The organization is being led by businessmen and scientists determined to unite those throughout America who are working to end this disease.

Sections of the Affordable Care Act that will go into effect in January 2014 will profoundly influence addiction care in America. Insurance will have to cover addiction treatments and other mental illnesses as comprehensively as they cover any other disease. For the first time, insurance will pay for whatever level of treatment is needed. Plus the more money available for treatment, the more jobs there will be for good and highly trained therapists and psychiatrists and other treatment professionals.

There’s a growing movement in America of addicts and family members coming out of the darkness. They are calling for a national and local focus on starting a war on addiction, not on drugs. (I’ve started a petition online that will be presented to President Obama. It’s a model based off the successful 1980s campaign to tackle the AIDS epidemic: Silence = Death. Silence = Death for addiction, too. Find a link at www.davidsheff.com.)

The top myths about addiction above were adapted from content from David Sheff’s new book, “Clean: Overcoming Addiction and Ending America’s Greatest Tragedy.

David Sheff makes a ‘Clean’ sweep of addiction

The author, who wrote a memoir about his son’s drug problem, is back to argue that substance abuse is an illness.

Q: First off, how’s Nic (now 30) doing these days?

A: Miraculously, he’s doing just great. He’s sober now for about five years, which is the most important thing after his struggles of a decade. He’s in L.A., doing lots of fun stuff.

Q: You look back now and wonder what you’d do differently with Nic, asking yourself, “How could I have…” over and over. What’s the answer to that question? Was there a co-dependence?

A: Yes, in a word. I think I definitely was in denial for a long, long time. Parents like me are wired for denial because it’s just too scary to acknowledge our kids are on the descent.

Q: A lot of people still don’t believe addiction is a disease, but a moral failing. You don’t.

A: I don’t. It took me awhile. I felt that he should just stop, especially when it was becoming life-threatening. It didn’t make any sense. I thought he was making a choice. But I know now it’s a disease. You can’t just stop.

Q: You say we need to fix what’s wrong in an addict’s life in order to fix his addiction. Easier said than done, no?

A: It is. But it’s required. One of the things I discovered is that the reason they have a drug addiction is because they’re using drugs to either escape from or treat other problems in their lives. Whether it’s stress or mental illness or some trauma.

Q: You admit that addiction isn’t curable, but it can be controlled. With drugs, even?

A: Yes. What scientists have learned is that addiction is a chronic illness, which means that even after it’s treated, someone is susceptible to relapse for the rest of their lives. Many people need these medications, and many illnesses respond to medications. Many of them work. Many take away the cravings.

Q: You’re not a big fan of 12-step programs like Alcoholics Anonymous. Why?

A: I actually am a fan of the program. They’ve saved many lives. But I do criticize the insistence that some programs require participation in 12 steps, as if it’s the only way, and it’s not. That view kills people.

Q: Why are young kids so strongly drawn to drugs?

A: Kids’ brains are developing with that part of the brain that is all about pleasure- seeking and impulsivity. It develops faster than the part of the brain that regulates that. It’s stressful to grow up, and kids feel more comfortable in their own skin with drugs.

Q: And how can their parents, like you, be so clueless about what’s going on right before their eyes?

A: Part of it is we’re not educated and we don’t know what to look for. We don’t take it that seriously. But the other piece is that denial is such a powerful force.

Q: What are some of the warning signs parents can look for?

A: I would say dramatic and troubling behavior. If you think something’s wrong, something’s wrong. If the kid is stressed out, withdrawn, less communicative. I think those are the warning signs. Drops in their academic performance, too.

Q: A relapse is not a failure, just a part of recovery?

A: Yes. Relapse is very dangerous. However, relapse can be a symptom of the disease. Sometimes there are multiple relapses before you get sober and stay sober.

Q: You say that nine out of 10 people who become addicted began using before 18, and if you get to 21 without ever using, it’s certain you never will. Can that be true?

A: Well, there are still no guarantees, but adults getting addicted are far more rare.

Q: An addict’s brain is different from birth? How so?

A: There is a different response to chemicals. Variations in the system. That’s why of the 10 kids who are smoking a joint, nine will be fine. The one has a brain wired differently.

Q: Interventions — yes or no?

A: If necessary, with the guidance of the trained psychologist. But in the wrong hands, it can be dangerous.

Q: The cold-turkey approach — dangerous?

A: Well, yes. There’s an idea that they have to pay for their sins and go into withdrawal. But it’s not necessary. And they can die.

Q: And you don’t believe in the tough-love approach, either?

A: No, I don’t believe in tough love. I just believe in love.

Q: Or group therapy? You say lots of therapists don’t know what they’re doing and do more harm.

A: They’re behind the curve. Until recently, the medical community hasn’t signed on to the fact that addiction is a disease. Many doctors are stuck in the idea that addiction is a choice, and they don’t treat that.

Q: What one thing do you want people to take away from this book?

A: That addicts are ill. If someone you love had cancer, say, you’d go see a doctor. And this is the same. Go see a doctor.

Q: Binge drinking, followed by the rash of recent car accidents involving teens, is a big problem. So, back to the parents again. What can they do?

A: Kids have to be educated. Parents have to pay close attention and monitor them. There are rules and expectations, with clear repercussions. Some parents want to be popular, but that’s not their job.

Q: Did you ever in your wildest dreams think addiction was going to become your life’s work?

A Father Tells The Story Of His Son’s Struggle To Stay ‘Clean’

Why do we imprison people who are addicted to illegal drugs instead of treating them for their addiction? That question is at the heart of David Sheff’s new book Clean: Overcoming Addiction and Ending America’s Greatest Tragedy. It reports the latest medical and scientific research about addiction and recovery, which, Sheff says, shows that drug addicts are gravely ill, afflicted with a chronic, progressive and often terminal disease.

Sheff’s research is motivated by having watched his son Nic’s addiction nearly destroy him and the family. Nic started smoking marijuana when he was 12 and eventually moved on to shooting heroin and crystal meth. He became homeless, living on the streets, in cars, in parks, and when he did come home, he stole from and lied to the family. Sheff wrote about how the family lived through his son’s addiction in the best-selling memoir Beautiful Boy. Nic wrote about his addiction in two memoirs and has been clean for five years.

David Sheff joins Fresh Air‘s Terry Gross to talk about his family’s experience and why he feels the nation’s approach to drug treatment failed his son.

Interview Highlights

On the first time his son got high

“Nic describes the first time he used in high school as transformative. It wasn’t so much about being high — it was about feeling OK for the first time in his life. He said that he didn’t know it was possible to feel an absence of the intense anxiety that he felt, the intense depression. So when he got high, it was just life-changing.”

“Addiction is a disease like anything else. It’s like cancer, like heart disease, like diabetes. And we know that at the first signs of serious illness, we want to seek treatment.

On why we shouldn’t wait for a person to hit rock bottom before getting them help

“I’ve heard over and over again, we’re told that they had to let their kids, you know, their husbands, their wives, whoever it was, they had to stand back, not to intervene, let them hit bottom so they would crawl into a treatment and say, ‘Please help me.’ That idea, it is so dangerous. It has killed so many people. The other problem with it is that this is a progressive disease, which means that as long as it’s not being treated, it gets worse. So the longer we stand back and allow this to happen and allow the drug use to continue and allow the behavior that is caused by the drug use to worsen so that someone is going to use more drugs and it’s just a cycle, the harder it is to treat them. So addiction is a disease like anything else. It’s like cancer, like heart disease, like diabetes. And we know that at the first signs of serious illness, we want to seek treatment. If someone in our families had early warning signs of any of those diseases, we would bring them to a doctor to figure out what is going on. We would not wait until the disease progressed.”

On his son’s most recent relapse

“He’d been sober for a long time. It was after Nic and I talked to you on your show and, you know, one day we were together and he said, ‘I cannot believe what I did. I was at someone’s house. Just almost automatic, I opened up the medicine cabinet. There was a bottle of Vicodin. I thought to myself, ‘Just one,’ which is common for addicts. That’s the first thing that they’ll say to themselves and to us, and soon the bottle was gone and he said, ‘I woke up this morning and realized that if I don’t do something I am going to be back on the streets within a week.’ So this was the first time I didn’t have to say a word. He got on the phone, he called the Hazelden treatment center in Minnesota. He was on a plane that day. To me, it’s possible to look back on that and say all the treatments before that were a failure: Here he was sober for such a long time, and he relapsed again. But for me, it’s the opposite: It shows that the treatments had helped him so much that he was able to recognize that he was in a free fall.”

On one of the problems he has with the 12-step program

“The 12 steps are a completely profound treatment for so many people, but not most people, and that’s the problem that I have. It’s not with the 12 steps. It’s only in the programs many, many rehabs are based on, this idea that the 12 steps are the key, are the only way to stay sober. That’s my problem. You get people in treatment — especially teenagers — I mean, what is it to be a teenager? It is to feel, you know, this powerfulness, and part of the 12 steps is that you have to admit that you are powerless over your addiction. You have to turn your life over to a higher power, you know. Teenagers, some do, of course, but part of being a teenager is [that] you’re not going to turn your life over to anyone.”

David Sheff wrote a book in 2008 that became a kind of landmark. Beautiful Boy was a painful, personal story of the battle he tried to fight with and alongside his son, Nic, who was addicted to methamphetamines. The book became an international best-seller and made David Sheff one of the country’s most prominent voices on addiction — not as a doctor, an addict or an academic expert, but as a father.

Sheff has continued to try to figure out a road that can lead out of addiction, and he presents that route in his new book, Clean: Overcoming Addiction and Ending America’s Greatest Tragedy. He joined NPR’s Scott Simon to talk about prevention, treatment programs and the legalization of marijuana.

nterview Highlights

On the biggest misconception about addiction

“I guess it’s this very deeply ingrained idea that addicts are choosing to get high and so they are reprehensible and they’re weak. But what we know now is that addicts aren’t immoral, they aren’t weak; they’re ill. They have a disease. And for me, when I finally realized that about Nic, that he was sick, and that’s what explained this unconscionable, crazy behavior, it allowed me to look at him with compassion, and to figure out, instead of with anger, just, how do I help him? How do we save his life?”

On why it’s crucial to catch addiction early

“This is one of the most complicated diseases there is because this is a brain disease. So the nature of this disease — the thinking is impaired, the self-preservation mechanisms — everything is about getting drugs. It’s a biological force. Drugs shift the way that we think. So, yeah, the logical thing would be to get help, but that’s not the way addicts operate, which is why it’s really, really hard to get someone to understand that they need treatment. If we catch this early, it’s not as difficult to get someone into treatment.”

On whether addiction is preventable

“I know it’s preventable. I mean, the way we’ve done it in the past doesn’t work. ‘Just say no’ doesn’t work. … Instead, we know that fact-based education works. … If we learn about the risk factors: stress; certainly if someone has a mental illness, they’re more likely to use drugs; if they’ve experienced some trauma, divorce, in their lives. We have to help kids through those things, and also we have to pay a lot of attention. A doctor that I interviewed said, ‘If you think something’s wrong, something’s wrong.’ And that’s the time to figure it out, you know, get help. Drag a kid to therapy, if that’s what it takes.”

I think that we need to legalize pot so we can start a new conversation and deal with this for what it is. It’s not a criminal problem and shouldn’t be treated as a criminal problem. It’s a health problem. So we need to focus on education and not punishment. – David Sheff

On whether legalizing marijuana is a good idea

“Well, actually, I support legalization. But there are a lot of people that support legalization who say things that are just wrong. They say that marijuana should be legalized because it’s harmless, you know, it’s natural, and no one has ever died from marijuana, you can’t get addicted to marijuana — those things are all untrue. Marijuana is not innocuous. There’s a lot of research — again, this especially pertains to teenagers. Their brains are developing, marijuana changes the development. … The effects include problems with their cognition and memory and motivation and there’s some evidence that it even lowers IQ. So, I think that we need to legalize pot so we can start a new conversation and deal with this for what it is. It’s not a criminal problem and shouldn’t be treated as a criminal problem. It’s a health problem. So we need to focus on education and not punishment.”

On why so many treatment programs fail people

“The only credentials that rehab counselors have in some places is that they’re an addict who’s in recovery. You want to go into programs that are accredited because they use evidence-based treatments, and so few do. It’s really, really hard. And it’s why we’re losing so many people — 350 people a day are dying from this disease. It’s tragic, and it’s even more tragic because it’s preventable.”

On Nic’s slow recovery

“When Nic, my son, got addicted — when it was clear he was disappearing, he was stealing from us, he was lying — I got a call from the emergency room, you know, ‘Mr. Sheff, you’d better get here. Your son isn’t going to make it.’ I had no idea what to do. I called people I knew who’d been through this. I looked on the Internet, completely overwhelmed. I ended up making the best decision that I could. It was relying on a friend of a friend of a friend who told me that their child had gone into a program and had done well. I sent Nic there, and at least it got him off the streets. I mean, it didn’t stop him from relapsing — he relapsed many times over the course of the next 10 years — but he was off the streets, he got some help. They call this sort of a treatment ‘trajectory.’ It takes a lot of time for some people, and it takes multiple treatments. Every relapse is dangerous, but often it takes multiple relapses before someone finally gets sober for good.”

The war on drugs was lost because the war on addiction was never begun

The death last month of the Glee star Cory Monteith was tragic. All deaths are. But it is even more tragic when it could have been prevented — like Monteith’s.

Because of Monteith’s death from an overdose of heroin and alcohol, addiction is having its latest fifteen minutes of fame. Fifteen minutes, however, are better than none to serve as a reminder of the prevalence and perniciousness of this disease. It’s unfortunate that it takes the death of a TV star—a Canadian in this case, but beloved in America and thought of as one of our own—to talk about a disease that kills three hundred and fifty people every day.

In the ubiquitous coverage of Monteith’s overdose, I haven’t heard any commentator express the fact that this death isn’t merely sad. It is appalling­—because it might have been prevented if it weren’t for failed drug policies.

The so-called war on drugs, which President Nixon launched in 1971, has been a war on millions of addicts, including ones just like Monteith. This approach has treated the problem as though it could be stopped by interdiction, arrests, and incarcerations. Addicts, Monteith among them, have been viewed as weak willed and derelict and treated as criminals rather than what they are: People afflicted with a chronic and potentially fatal illness. (In my last Medium column, I explained the disease of addiction.) If, before his death, Monteith had been caught with drugs and paraphernalia in his possession, he would likely have been arrested. But arresting people who are ill isn’t only inhumane, it’s counterproductive: When addiction isn’t treated, it worsens. If the U.S. hadn’t spent decades and more than a trilliondollars fighting the war and instead spent the time and money to improve prevention and treatment, Monteith might have been healed, and so might every other addict.

As I report in my book Clean, in North America and the rest of the world, the chorus of voices calling for an end to the war on drugs is getting louder. The Global Commission on Drug Policy—members of which include economists, policy experts, and several former world leaders—former Secretary of State George Shultz, former chairman of the U.S. Federal Reserve Paul Volcker, and entrepreneur Richard Branson, among others—have declared that “the global war on drugs has failed, with devastating consequences for individuals and societies around the world.” Speaking at the Brookings Institution last year, New Jersey Governor Chris Christie said, “The war on drugs, while well-intentioned, has been a failure.” Soon thereafter, the NAACP took a stand: “Today the NAACP has taken a major step towards equity, justice and effective law enforcement,” said Benjamin Todd Jealous, the organization’s president and CEO. “These flawed drug policies that have been mostly enforced in African American communities must be stopped and replaced with evidenced-based practices that address the root causes of drug use and abuse in America.” In a New York Timeseditorial, Fernando Henrique Cardoso and Ruth Dreifuss, the former presidents of Brazil and Switzerland, respectively, argued that the war should be ended because of the appalling human-rights violations perpetrated in its name. The chorus now represents a majority of the American people. In a recent poll, only 10 percent of Americans said they considered the War on Drugs a success. Two-thirds of those polled, including the majority of both Democrats and Republicans, said it was a failure.

They’re right. The war has decimated families and communities, encouraging an out-of-control cycle of violence, addiction, and crime; targeted racial minorities; and killed tens of thousands of civilians in Mexico and other countries. It is responsible for America having more people imprisoned than any other country in the world, even China or Russia. And then there’s the money: the trillion-plus dollars that could have been used on social programs, especially ones that would have prevented addiction from flourishing.

The war has also exacerbated the nation’s current number-one drug problem, prescription-pill abuse, which leads to more non-natural deaths in America than any other cause. For these addictive medications, physicians and pharmaceutical companies, not cartels, are the suppliers. Meanwhile, prescription-medication misuse is fueling a new and mounting heroin epidemic. Many OxyContin and Vicodin users grow addicted and turn to heroin because it’s cheaper than pharmaceuticals and much easier to score. So much for the effectiveness of the drug war. It’s by now a familiar refrain: targeting the drug supply doesn’t work.

In Clean, I tell the story of a boy named Luke Gsell, who became addicted at fourteen. Gsell said that his need for drugs was such that when he couldn’t find ecstasy, pot, or cocaine, he’d “take gasoline out of the lawnmower and huff that.” People who want drugs will find them, and as long as people want them, any war that focuses on the supply of drugs is destined to fail.

The drug war has failed, but in this debate, few address a critical question. Can we afford to accept defeat? Drugs kill 120,000 people a year and cost the nation more than four hundred billion dollars, mostly in health care, criminal justice, and lost productivity. Twenty million Americans are addicted. Few of those who have called for an end to the war have offered specific solutions, instead mostly issuing a generic and obvious call to lower demand. But how?

There is a solution, and a model to follow. If we’re finally going to take on America’s drug problem effectively, we must end the war on drugs and instead fight this like we fight other diseases. We must effectively take on the disease of addiction.

Simultaneously with ending the drug war, we must work to cure addiction, just as we have worked to cure other diseases. Cancer. Heart disease. HIV AIDS. More money for addiction research is necessary. It could lead to significant advances in the creation, testing, and dissemination of effective addiction prevention and treatment. If we were to begin dismantling the drug war by budgeting, say, a third of the money currently allotted for curbing the supply, the paltry one-billion-dollar budget of the National Institute on Drug Abuse (NIDA) could be quintupled. Access to more money could allow NIDA and the researchers it funds to improve current prevention strategies and treatments and develop new ones, including addiction vaccines, prevention programs for children and young adults of all ages, medications, and behavioral treatments for the addicted. By starving NIDA and researchers around the nation of the money to improve existing treatments and find new ones, the administration is impeding progress. By failing to work with the states to create a national treatment system based on evidence-based practices, the government is allowing the perpetuation of the current system, which is based on pseudoscience and best guesses and does not work for most addicts who make it into rehab, and only one out of ten ever receive any treatment whatsoever.

It’s too late for Cory Monteith. But when we change our focus and fight the war on the disease of addiction, we’ll save the lives of countless others like him.

This article by Glenn C. Altschuler and Patrick M. Burns was published at HuffingtonPost.com.

Free Will Hunting

Substance abuse and addiction have reached epidemic proportions in the United States. Every day, on average, about 8,120 individuals age 12 and over try drugs for the first time and 12,800 try alcohol. About 60 million people binge drink. Mortality rates from abuse of prescription pills are skyrocketing. All-in-all, in addition to destroying families, devastating inner cities, and causing crime and car accidents, substance abuse is responsible for more deaths than any other “non-natural” cause.

In Clean: Overcoming Addiction and Ending America’s Greatest Tragedy, David Sheff, the author of Beautiful Boy, a moving account of the addiction and treatment of his son, Nic, draws on research in psychology, neuroscience and medicine to present a new approach to dealing with what may well be our greatest social problem. Sheff insists that addiction is an incurable but treatable disease, not a moral failing. Since choice “has nothing to do with the disease,” he emphasizes, it is counter-productive to exhort young people to “Just say no” or dismiss addicts as dissolute or undisciplined. Treatment must be based on evidence, not urban legends, guilt or wishful thinking.

Providing a wealth of information and practical advice, Clean is the best book on drug abuse and addiction to appear in years. Sheff’s claims about choice, however, raise far more questions than they answer.

Clean busts a mountain of myths. People living below the poverty line, he reveals, are 100 percent more likely to abuse or be addicted than more affluent individuals. Sheff cites studies that show that the DARE program, which is used in 75 percent of the nation’s school districts, may actually raise rates of drug use. He demonstrates that addicts will not respond best if they’re allowed “to hit bottom.” He makes a compelling case that “no one really knows how often AA works and for whom,” and that we do know that AA retention is low and attrition is high. Although he cites no studies, Shef claims that “the science based approach rejects cold-turkey detox.”

Sheff also makes specific recommendations about treatment options and how to make informed selections. He sorts out types of accreditation and licensing for facilities; favors programs where psychologists, clinical social workers and family therapists are “full-time and don’t just stop by weekly” and psychological and physical examinations and medications (if necessary) are administered on site; and he advises nailing down ahead of time the assistance staff will provide with a transition to a new program when the patient is ready or he or she has been expelled.

Grounded in evidence of genetic predispositions and the effect of drugs on the brain, Sheff’s main theme — that addiction is a disease, not a character flaw — does counter a pervasive and pernicious tendency to “blame the victim” (or the parents of the victim). But it leaves us struggling to comprehend the role of “free will” in resisting the disease.

In our judgment, Sheff is neither consistent nor clear in distinguishing between drug abusers and addicts or in finding a way to understand or explain the choices users make. Hard put to explain “why some people do stop using on their own,” he speculates that members of this small group “aren’t as addicted in the first place.” His analogy, that “blaming an addict for relapse is like blaming a cancer patient when radiation and chemotherapy don’t work,” doesn’t seem entirely appropriate.

Throughout his book, it is worth noting, Sheff acknowledges that choices are available to abusers and addicts. “Before a person can change his behavior,” he writes, “[he] has to want to change it.” Motivational interviewing “can help addicts understand the conflict between their life goals and their drug use.” Given “cues” during Cognitive Behavioral Therapy, Sheff asserts, addicts can be taught to select alternative behaviors to defuse triggers — like going for a run — when they reach a “choice point.” When Luke Gsell took Dramamine and drank beer while in rehab to celebrate his 15th birthday, came down from it, recognized he was an addict and vowed “I’m done with this,” Sheff declares that “if he needed confirmation that his decision was a smart one, he received it the next day,” when his roommate OD’d after taking 36 pills. And in the appendix to Clean, Sheff concludes, “If kids are to make informed choices about drugs, they need to have facts about them. They need to know what they’re risking in order to get high.”

Free will is an elusive and enigmatic concept. Although philosophers have gone free will hunting for centuries, they have never really understood why people choose what they choose. Nor is free will yet amenable to measurement by scientists. We believe that choice, as it is commonly understood, and as Sheff himself uses it, is relevant to the scourge of abuse and addiction, and to the tactics, strategies, and policies his extraordinarily valuable book lays out to help us to overcome them.

Glenn C. Altschuler is vice president for University Relations and the Thomas and Dorothy Litwin professor of American Studies at Cornell University.

Patrick M. Burns is associate director of Young Alumni Programs at Cornell University.